Monthly Archives: May 2011

Clinical Pearl

If you are treating hepatitis B and are unable to normalize ALT levels, be sure of three things: (1) are they taking the Rx everyday? (2) has drug resistance developed? and (3) do they have a hepatitis delta superinfection? Advertisements

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Definition: secondary sclerosing cholangitis

Secondary sclerosing cholangitis is a mimic of primary sclerosing cholangitis (PSC) in its biochemical profile, radiographic appearance and clinical behavior.  Instead of being primarily immune mediated, it occurs as a secondary reaction to an insult like infection, ischemia, surgical complications or a … Continue reading

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The Sunday Chronicles

“I dare you to read the first twenty pages and not keep going.”  – Chicago Tribune “Is there another living writer with as firm a grasp on the subject? One word- No!” – USA Today “A Tour de Force.”  – … Continue reading

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Pathology: leukonychia

Leukonychia, or “white nail” is sometimes found in liver disease.  In particular, it may be an indication of hypoalbuminemia.  With a high pre-test probability of late-stage disease (ie. thrombocytopenia, hyponatremia) synthetic dysfunction may be reflected in the nail exam.  Remember … Continue reading

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Journal club: Pioglitizone, vitamin E, or placebo for nonalcoholic steatohepatitis

(NEJM, May 2010) In this study, 80 patients received pioglitazone 30 mg/day, vitamin E 800 IU/day or placebo for two years.  Nobody had diabetes mellitus, though insulin resistance was present.  Biopsies were performed before and after.  Major side effect included … Continue reading

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Clinical Pearl

If you suspect a patient is abusing alcohol, think outside the box and order GGT (if alkaline phosphatase is normal) and IgA levels.  Each of these may be elevated during alcohol abuse.

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Clinical Pearl

Recognize that when a common bile duct is obstructed by a gallstone, the intrahepatic bile ducts may not dilate if the liver is cirrhotic, due to its firm, non-expansile nature.

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